Perinatal & Pediatric
State-level payday loan bans and preterm births in the US, 2000 to 2019 Parvati Singh* Parvati Singh Samantha Gailey Tim A. Bruckner Rania Badran
Payday loans refer to high-interest, short-term loans. These loans can provide immediate financial relief for individuals with limited access to traditional credit. However, the predatory nature of payday loans may portend increased financial strain and adverse public health consequences. Payday lending may contribute to elevated risk of preterm birth- a leading cause of infant mortality- in an exposed population. In line with expectations from the Social Ecological Model of Health, payday lending may not only reduce individual assets but also reduce community resources, divert investments away from health care systems, and worsen economic inequality and increase social and economic distress. We examine whether state-level temporal variation in payday loan restrictions over a 20-year period (2000–2019) corresponds with a reduction in preterm births in the US. Between 2000 and 2019, 10 US states and the District of Columbia imposed restrictions on payday lending at varied time points. We use data on preterm births provided by the CDC Wonder database (2000–2019) and apply staggered difference-in-difference and event study approaches to examine whether preterm births (per 100 live births) declined among states that imposed payday lending restrictions, relative to states that never imposed restrictions. We also control for state-specific time propensity of preterm births, derived through time-series analysis. Results indicate a decline in the preterm births by approximately 2% (95% CI: -0.40, -0.03)) within the first 3 years of payday loan restrictions, which corresponds to more than 4500 fewer than expected preterm births. Our findings suggest that ecological mechanisms that potentially reduce toxic macroeconomic exposure to payday lending may correspond with a reduction in preterm births at the population level.
